Cascading cuts result in new home care restructuring

The government is coordinating cascading efforts to move patients from organizations where more care is provided to where less care is provided.

For hospitals, government funding models and directives have long focused on removing less ill patients.

In long term care homes, the government quietly raised the criteria for eligibility for the waiting list. They also stopped providing the 'case mix measure' which was the key measure of the increasing illness and acuity of long term care residents. Regardless it is now obvious acuity in the homes is rising rapidly.

But these restrictions on eligibility to hospital and long term care homes have also dramatically increased demand for home care services provided by Community Care Access Centres (CCACs). CCACs are facing both more demand and much more ill patients. The CCACs claim the number of their high care need patients have increased 73% between 2009/10 and 2013/14. As a percentage of total patients, high care need patients have increased from 37% to 64%, while patients with less intensive care needs has dropped from 63% to 36%.

Home care is dramatically changing.

The government has responded to this by eliminating a whole class of "clients" from CCAC care.

The "Collaborative Care Model" will see less ill home
care patients transfer from the CCAC to Community Support Service agencies
(CSS). The CSS agencies will take over clients who are stable,
independent, and have low to moderate care needs CCACs will maintain care for sicker
patients (post acute or complex patients). Indeed moving to more acutely ill patients is required by the HBAM funding system.

In March 2014, the government enacted a new regulation to allow Local Health Integration Networks (LHINs) to directly fund designated CSS organizations to
deliver personal support services. These regulations came into effect on July
1, 2014. Specifically Regulation 386/99 under the Home Care and CommunityServices Act, 1994 was amended to enable lighter needs clients to
receive personal support services (PSS) through selected CSS agencies by extending
the eligibility criteria and service maximum to all approved agencies.

The regulation establishes (barring exceptional circumstances) a maximum number of hours of personal support and homemaking services :

120 hours, in the first 30 days of service.

90 hours, in any subsequent 30-day period.

Despite this seemingly generous maximum, the reports we have received is that the changeover to the new regime has gone with reductions in the amount of care.

The CSS organization can directly take on a client now - there is no need to go through the CCAC (the slogan is there "is no wrong door").

LHINs are awarding money for these new contracts right now. The Hamilton-Niagara LHIN recently planned to reallocate $4 million in CCAC funding in 2015/16 to CSS providers in supportive housing and assisted living settings. That is supposed to provide 127,795 hours of care (at, apparently, a total cost of $23.47 per hour). The providers named were the March of Dimes in Niagara and Hamilton, St. Joseph's Homecare, AbleLiving Services, Capability Support Services, Participation House Brantford, and Good Sheppard Hamilton.

The LHIN notes that "In late summer 2014, the HNHB CCAC informed the HNHB LHIN that in order to
accommodate increased referrals from hospitals and community for persons needing
higher levels of care the CCAC would need to transition persons assessed as
requiring lower levels of care to community support agencies."

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